Radionuclide and angiographic studies of placental circulation in man and rhesus monkey. Imaging maternal and fetal circulation during perfusion of isolated human placental lobules was performed. Radionuclide and contrast angiograms, specimen scans, and histologic preparations obtained on human material during in vitro investigations were compared to the results obtained in vivo on pregnant rhesus monkeys. The distribution of maternal blood flow within the placenta appeared similar in both human and rhesus studies. The 'spurts' of radiopaque medium shown on the contrast angiograms correlated with the appearance of areas of increased radioactivity. These 'hot spots' are located where the uteroplacental spiral arteries open into the intervillous space or where the perfusion cannulae irrigate the maternal side of the placenta. Time-radioactivity curves reached an early peak and remained the same as did their distribution on delayed scans. The 15 to 30 micron microspheres injected into the intervillous spaces are not removed onto the venous side by maternal flow through arteriovenous communications (or 'shunts') but are retained in localized areas of the intervillous space adjacent to the spiral arteries. Many of these microspheres adhere to the 'brush border' of the chorionic villi syncytiotrophoblast. These comparative studies confirm that rhesus monkeys and perfused human placental lobules are relevant models to investigate uteroplacental hemodynamics.


Evaluation of fetal heart rate in relation to the intrauterine 20 mm Hg level. The purpose of the author's study was to investigate whether any changes in fetal heart rate (FHR) and in fetal acid-base status could be observed when the intrauterine pressure rises above 20 mm Hg. 16 primigravidae were studied. In 11 out of 16 patients labor was induced by amniotomy, in 9 cases oxytocin was given, and in 12 patients pethidine and promethazine (Phenergan) was administered. Two new parameters were introduced into the study of the collected material: the peak variation in FHR (bpm) i.e. the difference between the highest and lowest FHR over a given period of time; the contraction energy, i.e. the product of duration and intensity of intrauterine contractions as measured from the 20 mm Hg level. In 15 out of 16 women the mean peak variation in FHR was highest during a uterine contraction (greater than 20 mm Hg). After a uterine contraction (less than 20 mm Hg) the mean peak variation did not immediately return to control values. It is suggested that in the 16 patients studied, the increase in FHR peak variation during uterine contraction is basically caused by a slight transient fetal hypoxia, exaggerated during the expulsion period of labor by cord entanglement.


Prevention of postpartum venous thrombosis with low doses of heparin. Postpartum superficial and deep venous thrombosis were found in 22.3% and 5.3% of women with varicose veins who delivered vaginally, or by cesarean section. The preventive use of low doses of heparin (5,000 U every 12 h injected subcutaneously) in 116 parturients with varicose veins reduced significantly the incidence of postpartum venous thrombosis. None of the 26 women with previous thrombosis who received preventive treatment, developed such an event.


Parental smoking. Its effects on fetus and child health. Smoking is a risk factor in pregnancy. Maternal smoking reduces the birthweight by 150-250 g (dose-response relationship), shifting the birthweight (and length) distribution to the left. Reduction of birthweight without shortening of gestation creates a group of small-for-date babies. Intrauterine hypoxia seems responsible for the growth retardation in smokers' babies as in babies of mothers living at high altitudes. Cigarette smoking of the mother affects fetal oxygenation, due to high levels of COHb in the blood of both mother and child. This observation is strongly supported by animal experiments. The total of (abortions), stillbirths, early and late neonatal mortality (especially stillbirths) is higher in babies of smoking than in those of nonsmoking mothers and highest among the poor. Approximately 5% of all stillbirths and neonatal deaths must be attributed to the increased mortality risk for the infant of mothers who smoke during the second half of pregnancy. Pregnancies of smoking mothers show about the same increase in infant wastage as pregnancies at high altitudes. The babies of smoking mothers show little excess of congenital malformations, if any. The placenta coefficient is increased. This symptom of compensatory placental hypertrophy cannot avert some impairment of fetal nutrition. There is less preeclamptic toxemia in smokers than in nonsmokers, but a higher incidence of antepartum hemorrhage and placental separation. Concerning long-term effects, smoking during pregnancy seems to be associated with a slight impairment of mental and physical growth. When the mother is nonsmoker and the father smokes more than ten cigarettes daily, an increase in perinatal mortality seems probable. Smoke aggravates the asthma of children in about two-thirds of those whose parents smoke. Healthy children of smokers are sick more frequently (primarily respiratory illness) than those of nonsmokers. Smoking parents and teachers stimulate their children and pupils to start smoking. Once smokers children may remain smokers. From the polemics on cause (smoking) and association (smoker) regarding the effects of parental smoking on the health of the fetus, the conclusion must be that health workers involved in obstetrics have great responsibilities in the antismoking campaign.


Maternal anticonvulsants and perinatal risk. According to data found in the literature, children born to epileptic mothers on anticonvulsant therapy have an increased perinatal mortality rate, namely 2-3 times the average. The congenital malformations attributed to anticonvulsant drugs cannot fully account for this high mortality rate. A case is described in which a severe bleeding disorder manifested itself in successive offspring. A discussion follows in which this defect in blood coagulation in the newborn and the role played by vitamin K is considered as representing an important and preventable cause of neonatal death and morbidity. Other features of the postnatal syndrome (CNS depression, congenital heart disease, withdrawal symptoms, anemia) are mentioned in the case report. Suggested preventative measures employing vitamin K, folic acid and vitamin D are briefly discussed.


Traumatic avulsion of the pregnant uterus.


Ovarian morphology in oligomenorrhea.

Ovarian morphology in oligomenorrhea. An account is given of the ovarian histology on 38 patients complaining of oligomenorrhea. The majority of these patients, 22, had polycystic ovaries, but in 11 the ovaries were comparatively normal in appearance. In another 3 they were small and inactive. The remaining 2 cases had chromosomal anomalies. The polycystic ovaries could be divided into two groups, one showing little follicular activity, the other a great deal. The maturation of most follicles in all ovaries appeared to be restricted and antral follicles rarely grew beyond a diameter of 4-5 mm. It is suggested that this degree of maturation is related to a low tonic secretion of FSH. An excessive production of luteinized thecal cells was found around most antral follicles. Polycystic change in these ovaries is mainly due to the presence of many atretic follicles. Luteinized thecal cells persist after atresia and it is suggested that this may be the result of a tonic secretion of LH. The lack of preantral and antral follicles in one group of polycystic ovaries may indicate a prolongation of the atretic process. Ovulation occurs with considerable frequency in these women. The mechanism is obscure.


Intermittent low-dose administration of prostaglandins intraamniotically in pathological pregnancies. A comparison with oxytocin and ergometrine. The effects of prostaglandin F2 alpha on uterine contractility were compared with the effects of oxytocin and ergometrine. All patients had an intrauterine death. 5 patients were induced with prostaglandin F2 alpha, given intraamniotically in low doses, starting with 125 micrograms. Doses were increased in relation to uterine activity. 5 other patients were induced by intravenous administration of oxytocin and ergometrine. Uterine pressure was monitored by a transabdominal open-tip catheter system. Results were quantitated in tonus (mm Hg), amplitude (mm Hg), frequency (number of contractions per 10 min), Montevideo units, active and total pressure areas per 20 min. Possible biochemical and coagulation changes were controlled before, during and after induction. Changes did not occur. Intermittent increasing small doses of PGF2 alpha increased uterine activity exponentially. Hypertonia persisting longer than 5 min was seldom seen with oxytocin or with PGF2 alpha. Ergometrine increased frequency of uterine contractions, without influencing tonus, probably due to a specific effect on the 'archemyometrium'. The induction-delivery interval was shorter in the PGF2 alpha group (range: 6-15 h) than in the oxytocin group (range: 7-24 h). In the latter group more inductions were necessary to complete delivery. Using PGF2 alpha in these small doses did not cause any side effects. With the intraamniotic injections, starting with 125 micrograms PGF2 alpha, clinical results are the same as those reported in the literature for high doses.


Immature delivery after intrauterine Candida albicans infection. The case is presented of a patient who delivered an immature infant after an intrauterine candidial infection in the presence of an intrauterine contraceptive device (IUD). 8 other cases of intrauterine Candida infection leading to immature deliveries were gathered from the literature. On the basis of the pathologic findings, the medium of infection is thought to be the amniotic fluid.


An approach to the treatment of hypertension in the aged. Because of the multiplicity of disease conditions and diminished tolerance for drugs in the aged, it is necessary to know concomitant pathologic conditions to determine which antihypertensive drug to use. In the Philadelphia Geriatric Center, there are about 1,000 residents, between 70 and 100 years of age. About 40% have hypertension; almost 50% have or once had depression; there are many cases of hiatal hernia and/or peptic ulcer; in one subdivision of residents, almost 40% have renal disease with BUN above 30 mg/100 ml. In antihypertensive treatment, some individuals respond fairly well to reassurance and weight reduction, when obese, even without drugs. All are given a low-salt diet. A diuretic is first used--thiazide in cases of good renal function, furosemide with impaired renal function. Liquid potassium supplements are given. If there is but little reduction in blood pressure in several weeks, methyldopa is added in ascending doses, in cases with or without renal impairment. In hypertension with impaired renal function, furosemide and/or methyldopa were especially valuable. Furosemide as an antihypertensive drug was also noted to delay the onset of congestive heart failure. Since reserpine can aggravate peptic ulcer and can precipitate or aggravate depression, it should seldom be used to treat hypertension in the aged. Guanethidine is rarely used, since it can cause cerebrovascular insufficiency and marked weakness. High blood pressure should be reduced slowly in the aged, to avoid untoward effects.


Massive haemorrhage in elephantiasis neurofibroma.


The spectrum of arteriographic findings in Osler-Weber-Rendu disease. In Osler-Weber-Rendu syndrome, visceral organs are frequently involved in addition to cutaneous and mucous membranous lesions. Detailed arteriographic investigation of 5 patients with this abnormality disclosed characteristic angiodysplastic lesions involving the lungs, liver, spleen, pancreas, gastrointestinal tract and mesentery. Arterial and aortic aneurysms appear to be an integral part of this abnormality. Common to angiodysplastic lesions is a variable degree of arteriovenous shunting. The arteriographic characteristics and the hemodynamic significance of major visceral arteriovenous shunts in hereditary hemorrhagic telangiectasia are discussed.


Treatment of the bradycardia-tachycardia syndrome with permanent demand pacing. The bradycardia-tachycardia syndrome (paroxysmal supraventricular tachycardia alternating with sinus bradycardia and episodes of sinus node arrest) has previously presented a complicated therapeutic dilemma when excitatory and suppressive drugs have been utilized. A patient with this syndrome successfully treated with a permanent ventricular transvenous demand pacemaker is presented. Various aspects of this syndrome as well as facets of diagnosis and treatment have been reviewed and discussed. Significant underlying cardiac disease was ruled out in this patient by the usual diagnostic methods including left heart catheterization and coronary angiography. An interesting possibility of the relationship of vagal stimulation secondary to hiatus hernia as an etiologic factor in this syndrome has been discussed. The opinion is expressed that the currently preferred method of treatment is the insertion of a permanent transvenous pacemaker alone or in conjunction with antiarrhythmic drugs, preferably digitalis and propranolol.


Renal artery embolectomy.

Renal artery embolectomy. A patient with rheumatic heart disease developed right renal artery embolism and was treated by renal artery embolectomy. After a brief historical data, etiologic factors, clinicopathologic points, and treatment of the disease have been discussed.


False positive 125I fibrinogen test.

False positive 125I fibrinogen test. 125I fibrinogen test was performed in 20 selected patients who presented with symptoms suggestive of deep venous thrombosis. The incidence of a false positive study was found to be very high: 90%. An increased accumulation of fibrinogen was noted over recent, well-healed surgical incisions, diffuse or focal inflammatory sites, hematoma and also, following a venogram or arthrogram test. The large number of coincidental circumstances that result in an abnormal accumulation of 125I fibrinogen lead us to believe that venogram is the procedure of choice in patients with symptoms simulating thrombophlebitis.


The role of metal ions in the activation of arginase. The role of metal ions as activators of arginase hydrolyzing arginine were studied. The metal ion is assumed to form a complex with arginine and to promote the enzymatic reaction. The activating ability of the metal ion appears to be governed by the chelating ability and/or the coordination numbers which determine whether the metal ion combines with the enzyme or the substrate (or both substrate and enzyme) and factors which influence the configuration of the resulting complexes.


Marfan's syndrome: cardiovascular manifestations.


Acute and chronic venous insufficiency in the finger. Venous hypertension with subsequent chronic venous insufficiency and its sequelae in the hand is reported as an uncommon complication of arteriovenous fistulae for hemodialysis.


Malate dehydrogenase and glucose-6-phosphate dehydrogenase activity in livers of Ni-deficient rats. In experiments using rats it was shown that inadequate dietary supply of Ni reduces growth and lowers the erythrocyte count, hematocrit and hemoglobin level in blood, that the Ni supply affects the trace element content of iron, copper and zinc in various body organs, and that the absorption of iron is greatly impaired by Ni deficiency. For further biochemical criteria on the essentiality of nickel, the activities of two dehydrogenases, malate dehydrogenase and glucose-6-phosphate dehydrogenase, were measured in liver homogenates from two generations of rats at 30 and 50 days of age. In the 30-day-old rats of both the F1 and F2 generation, the activity of the malate dehydrogenase fell to about two-thirds the level of control animals. In the liver of the 50-day-old rats the activity of this enzyme was about the same in deficient animals as in the controls. The activity of glucose-6-phosphate dehydrogenase of Ni-deficient rats was reduced by 85% in the F1 generation and by 56% in the F2 generation at 30 days of age as compared with control levels. In 50-day-old rats the activity had fallen to half the level of control animals at 30 days of age. At the age of 50 days, there was no significant difference between the deficient and the control groups of either generation.


Inhibition of L-alanine aminotransferase by lithium salts. Pharmacologic concentrations of either LiCl, LiN03 and LiF or the lithium salts of pyruvic or glutamic acids inhibit the formation of alanine arising from the transamination of glutamate in the presence of pyruvate. Lithium pyruvate is the most effective inhibitor, while the addition of K+ to the incubation reaction can effectively reduce this inhibition. Some possible modes of action of the lithium ion is presented.


Coordination of biogenic amines with synaptosomal and vesicular metal ions: equilibrium and spectral studies in model systems. Thermodynamic equilibrium studies using model systems were carried out on the nature and extent of coordination of twelve different biogenic amines and adenosine-5'-triphosphate (ATP) with the bivalent metal ions, viz., Ca2+ and Zn2+, which occur in the subcellular fractions of the brain, at 25.0 +/- 0.1 degrees C and at an ionic strength of 1.0 (KNO3). In the combined presence of the individual monoamines and ATP the metal ions were predominantly coordinated by ATP in the pH range 3.0 to 6.5 with binding constants (log KML) of 2.84 +/- 0.06 and 3.19 +/- 0.39 for the Ca2+ and Zn2+ chelates, respectively. Each of the monoamines coordinated with the metal-ATP chelate above pH 6. The stabilities of the chelates of some of the amines with Ca2+ -ATP (1:1) system were NE, 2.33 +/- 0.33; AA, 2.24 +/- 0.19; OA, 1.94 +/- 0.29; NMeN, 1.60 +/- 0.22; DA, 2.14 +/- 0.09. Values for the Zn2+-ATP-amine systems were: NE, 8.35 +/- 0.26; OA, 4.53 +/- 0.07; DA, 10.05 +/- 0.39. Absorption spectral studies were carried out in order to examine the nature of coordination of NE, DA, TA, and AA with Cu2+, Fe2+, and Mg2+ ions in the combined presence of ATP. Results of the spectral studies taken together with the (thermodynamic) equilibrium data have indicated that in the pH range of biological interest, the catechol amines (NE and DA) and ATP are both coordinated to the "synaptosomal and vesicular" metal ions. The results further indicated that both the pyrocatechol and the ethanolamine groups of NE might be involved in the coordination of Cu2+. However, the interaction of the ethanolamine group of the NE molecule with the rest of the metal ions was not indicated.


Protein-metal ion interaction: volume effects produced by the interaction of proteins with metal ions. The interaction of metal cations with single chain globular proteins produces volume increases, the magnitude of which is determined primarily by the ion and to a lesser extent by the protein. The cations are listed in ascending order of volume change: K(I) less than Mg(II) less than Sr(II) less than Ca(II) less than Co(II) less than Ni(II) less than Cd(II) less than Zn(II) less than Cu(II) less than Pb(II). This sequence held for all cation-protein systems investigated except for Cd(II) which produced a slightly larger volume effect than Zn(II) with lysozyme. The volume changes attributed to protein-cation interaction are positive and range from 8 ml/10(5) g of protein for the reaction on 0.05 M KNO3 with bovine plasma albumin to 2320 ml/10(5) g of protein produced by the 0.20 M Pb(NO3)2-myoglobin system. A similar classification scheme was not possible for the proteins. For example, volume increases of 45, 50, 80 and 95 ml/10(5) g of protein were produced when 0.05 M Mg(II) reacted with bovine serum albumin, ovalbumin, sperm whale myoglobin and lysozyme, respectively. However, when 0.2 M Pb(II) was the reactant the values were 1930, 846, 2320, and 1120 ml/10(5) g of protein. Volume effects produced by Cr(III), Al(III) and Fe(III) were determined, but the calculated results are considered dubious because the volume changes are a complicated function of protein-cation and protein-proton interaction.


Cobalt(III) complexes of bidentate azotyrosine analogs. As analogs for cobalt(III) complexes of bidentate azotyrosine in proteins, several cobalt(III) complexes of bidentate azophenols have been prepared and characterized. Tris(2-phenylazo-p-cresolato)cobalt(III) was shown to be a poor model complex for this purpose; while cobalt(III) complexes of either 2-phenylazo-p-cresol or 2-(4-carboxyphenylazo)-4,5-dimethylphenol with the linear tetradentate ligand ethylenediamine-N,N'-diacetic acid are very useful as model complexes. The complexes were characterized by magnetic susceptibility, visible spectra and 1H NMR. In the case of one of the mixed ligand complexes, a detailed description of the stereochemistry was possible. Comparisons of the spectral characteristics of metal complexes with bidentate and tridentate azophenols are made. These model studies are essential to a program involving the site specific modification of proteins with substitution inert metal ions.


Methylation of chloroplatinate by methylcobalamin. Incubation of microM levels of K2PtCl6 and methylcobalamin (MeB-12) results in the complete conversion of MeB-12 to aquoB-12. Demethylation is optimal at pH 2.0 and is accelerated by the addition of K2PtCl4. The reaction is stoichiometric between MeB-12 and K2PtCl6 (1:1). Incubation of 40 microM K2PtCl6 with either 40 microM [Me-14C]MeB-12 or [Me-3H]MeB-12 followed by lyophilization converts 70% of the label to a stable form which is associated with Pt upon subsequent paper chromatography and electrophoresis. There is no preferential loss of 3H relative to 14C in the reaction product. When 50 mumoles each of [Me-14C]MeB-12 and K2PtCl6 were reacted and subjected to column chromatography, a labeled UV-absorbing product was separated with a 14C/Pt ratio of 0.9-1.2. The 14C-Pt product has absorption maxima at 260 nm and 208 nm with a minimum at 240 nm (A240 nm/A260 nm = 0.5). Proton NMR spectroscopy confirmed the presence of an H-C-Pt covalent bonding pattern (J for 1H, 195Pt = 78.2 Hz; tau for 194Pt-Me + 196Pt-Me = 6.956).


Cyclization of the phosphorus chain of the methylene-bridged analogs of adenosine triphosphate. The phosphorus-containing side chains of two methylene-bridged analogs of adenosine triphosphate have been cyclized to produce the corresponding analogs of monoadenosine-5'-trimetaphosphate. (The structures are given in the journal.) The molecules, which were generated in anhydrous media through a carbodimide-mediated condensation, were characterized by 31P nuclear-magnetic resonance, and the white-noise 1H decoupled spectra were simulated. These molecules are quite reactive and readily converted to their corresponding linear forms upon hydrolysis. The second structure contains an asymmetric phosphorus atom, and both of the possible cyclic molecules have been observed and the diasteroisomeric mixture has been isolated.


Conformational properties of the osmium tetraoxide bispyridine ester of 1-methylthymine and a comment on the linearity of the trans O=Os=O group. The preparation and crystal and molecular structure of the osmium tetraoxide bispyridine ester of 1-methylthymine are reported. The complex crystallizes in the triclinic system, space group P1, with a = 11.493(6)A, b = 16.655(7)A, c = 6.082(2)A, alpha = 92.07(3) degrees, beta = 90.58(3) degrees, gamma = 71.36(4) degrees, V = 1102.4 A3, Dm = 1.85(1) g cm-3, DC = 1.84 g cm-3. The unit cell contains 2 osmium tetraoxide bispyridine esters of 1-methylthymine, 2 waters of crystallization and 1 disordered pyridine of solvation. Intensities for 3814 independent reflections were collected by counter methods. The structure was solved by standard heavy-atom techniques and has been refined by full-matrix least squares, based on F, to a final R value of 0.065. The osmium complex binds as a cis osmate ester to the C(5)-C(6) bond of the methylated pyrimidine in a fashion which is expected to be similar to the binding of the complex to thymidine residues in nucleic acids. The conformation of the 1-methylthymine ester is that of a half chair with C(6) showing a substantial deviation, 0.55 A, from the best mean plane of the thymine moiety. The primary coordination sphere about the Os(VI) atom is completed by 2 axial Os=O bonds and the binding of the 2 pyridine ligands in cis positions in the equatorial plane containing the ester linkages. The O=Os=O group is substantially nonlinear, 164.0(5) degrees, and this nonlinearity is attributed to intracomplex electronic effects.


A combined ultrasonic and biochemical study of fetal renal function in the term fetus. The fetal glomerular filtration rate of plasma (GFR) and the percentage of fetal tubular reabsorption of water were measured by means of combined ultrasonic and biochemical methods in 20 normal and 10 complicated pregnancies. The duration of pregnancy varied from 35 to 42 wk. In normal pregnancy GFR of plasma varied from 2.0 to 7.1 ml/min (mean = 4.1) and tubular reabsorption of water ranged from 84.1 to 93.0% (mean = 89.8). There was no relationship with gestational age. In the group of complicated pregnancies - apart from one anencephalic case - no apparent difference in GFR and percentage tubular reabsorption between the group of normal (greater than or equal to 10th percentile) and reduced fetal birth weight (less than 10th percentile) was observed.


Binders of intravenously administered 65-zinc in rat liver cytoplasm. The fate of an i.v. injected trace dose of 65Zn2+ in the rat, was studied over a period of 10 days after injection. Tissue distributions were determined and a special study was made of 65Zn binders in liver cytoplasm. A total of 6 65Zn-binding fractions were observed in liver cytoplasm with apparent molecular weights of about 113,000, 66,400, 47,400, 29,000, 23,000 and 11,400. A time study showed that 4 hours after the injection the most prominent cytoplasmatic 65Zn binders are the 113,000, 66,400 and 23,000 molecular weight fractions. A tentative identification of the main Zn binders in the six 65Zn fractions is given, using the collected data regarding their apparent molecular weight, time dependent prominence and content of stable Zn.


Massive feto-maternal hemorrhage as a cause of perinatal mortality and morbidity. 11 cases of massive feto-maternal hemorrhage (FMH) detected at the Leuven Blood Transfusion Center are described. Based on these case reports, a review is given of the various theoretical and practical problems related to this complication, e.g. the relative frequency of perinatal mortality and morbidity due to massive FMH, the causes and pathogenesis, the symptoms and diagnosis, the clinical varieties, and the pathophysiology as seen in the fetus and newborn. Finally, the indications for looking for large FMHs are described, and the therapeutic implications when this complication is discovered.


Biological and immunological studies of a placental gonadotropic protein. Precocious sexual maturity, ovarian weight increase and stimulation of the sex accessory organs in impuber female mice, was induced by a partially purified protein fraction obtained from human placenta. The relationship between this biologically active protein and HCG was studied by a comparative immuno-double diffusion technique (Ouchterlony) and two agglutination inhibition tests. Results showed that this protein with gonadotropic activity is neither immunologically related to HCG nor contaminated with this hormone.


Chemical and biological characterization of an active substance of the human placenta. Acetic acid extracts of human term placenta have been fractionated by pH and salt precipitations and by exclusion chromatography on a Sephadex G-75 column. A partially purified fraction (F-II) possessing uterotropic activity in immature and young mice was obtained. This active fraction was submitted to the action of protein denaturating agents (heat, 8 M urea) and of specific proteolytic enzymes (trypsin, alpha-chymotrypsin and pronase). These treatments completely destroy the uterotropic activity showing that the active substance is of protein nature. The administration of F-II to spayed mice did not produce any increase in their uterine weight suggesting that the uterotropic activity would be due to stimulation of the female gonad.


Tubal and uterine motility in vivo in the rhesus monkey. Previous data indicate that there are definite qualitative and quantitative patterns of tubal activity during the various phases of the menstrual cycle. In the present investigation, the simultaneous activity of the uterus and Fallopian tube was recorded in vivo in mature rhesus monkeys throughout the menstrual cycle. The observations indicate that there are characteristic patterns of both tubal and uterine activity, depending on the various phases of the menstrual cycle. The simultaneous recordings of tubal and uterine activity show that the tubal and uterine contractions are not synchronous or even have a similar pattern. The presence of a transmetrial catheter for recording of uterine activity seems to modify the patterns of tubal activity, particularly during the ovulatory phase. It seems possible that the transmetrial catheter has a similar effect as an intrauterine contraceptive device in this species.


Fetal growth retardation in the second trimester. Growth of the fetal head was assessed by serial ultrasonic measurements in a prospective study of a randomly selected group of 126 mothers. Three cases exhibiting second trimester fetal head growth retardation with varying degrees of catch-up growth before term are illustrated.


Hemodynamic changes associated with angina pectoris induced by maximal treadmill exercise: effect of sublingual isosorbide dinitrate on systolic time intervals. A technique for the study of patients with angina pectoris has been described, in which systolic time interval (STI) measurements are obtained at intervals after the onset of stress-induced angina. The technique is uniquely suited to the evaluation of anti-anginal drugs. Sublingual isosorbide dinitrate (SISD) was randomly alternated with a placebo (P) tablet in a double-blind study of 20 patients with stable angina pectoris. After SISD, compared to placebo, a highly significant shortening of Q-S2 and LVET occurred (p less than 0.001) which lasted throughout the entire 120 minute study period. The hemodynamic basis for these differences was felt to be improved myocardial contractility secondary to a reduction in systemic vascular resistance and reduced venous return induced by the SISD. A significant prolongation of PEP occurred at 60 minutes post-SISD (p less than 0.01). This was attributed to an increase in the gradient between LVEDP and aortic diastolic pressure resulting from reduced venous return after SISD. The PEP/LVET ratio was significantly increased up to 60 minutes after SISD (P less than 0.05). Heart rate was uniformly higher post-SISD, compared to post-placebo values; the differences were highly significant up to 60 minutes (P less than 0.001) and remained significant at 120 minutes (p less than 0.05). The time to angina was significantly longer (immediately post SISD, p less than 0.05; 30 min, p less than 0.001; 60 mins, p less than 0.05; 120 mins, p less than 0.05); and the work load greater, for 120 minutes following SISD: the increase in the latter was highly significant for 30 minutes after SISD (p less than 0.001) and remained significant up to 120 minutes (60 mins, p less than 0.05; 120 mins, p less than 0.05). These observations were attributed to an improvement in myocardial function due to the sublingual isosorbide dinitrate. A high degree of correlation was found to exist between heart rate and the STI. This correlation was negative for the QS2 interval (-0.996) and LVET (-0.993) and positive for PEP (+0.817) and the PEP/LVET ratio (+0.950).


Neurogenic pulmonary edema: a sequella of non-hemorrhagic cerebrovascular accidents.


When does a fourth sound become an atrial gallop? A study of the fourth sound was conducted on 100 normal subjects (ages 1-88 years) and 42 clinical cases with either aortic stenosis, systemic hypertension or coronary heart disease. This study was based on the graphic recognition of a presystolic sound when the tracing was taken with the use of one or more of 5 different high pass filters. Attention was paid to the existence of the fourth sound, its magnitude, and its vibrational frequency. In general it was accepted that a magnitude of 1/2 of the first heart sound or a frequency of 30 Hz denoted a pathologic fourth sound. However, exceptions were found among normal subjects, so that only the combination of the two criteria could be considered highly significant for a pathologic phenomenon (gallop). Patients with aortic stenosis presented an increase in magnitude of the fourth sound but incidence and vibrational frequency were similar to those of controls. Patients with hypertension had a greater incidence of fourth sounds, especially in middle age (100%); middle age patients usually had a greater magnitude while older patients had more often an increase in vibrational frequency. Patients with coronary heart disease (evidence of old infarcts) had an increase in the incidence, magnitude, and vibrational frequency in comparison with controls. These data and the cause of the fourth sound are discussed. The fourth sound has been repeatedly studied in the past, both as an auscultatory finding and a graphic phenomenon. Attempts were made for separating the normal fourth sound from that denoting a pathological phenomenon but, so far, no clear cut criteria for the differentiation have been obtained. We thought, therefore, that a new study was indicated.


The occurrence of deep venous thrombosis following compression sclerotherapy.


Action of L-tyrosine and arachidonic acid on experimental arterial hypertension in the rat. Physiological and pathogenic deductions.


Daily tobacco consumption and electrocardiography [P1 and T1]. The unfavorable electrocardiographic effect of cigarette consumption in a large sample of health professionals [doctors and their wives] confirms earlier such reports in smaller groups.


Incidence of venous thromboembolic disease in nonpregnant women of childbearing age. Data from 12 Cincinnati hospitals were examined to determine the incidence of venous thromboembolic disease in nonpregnant women of reproductive age. The incidence of superficial and deep vein thromboembolic disease in women age 15 to 44 was 1.09 cases per 1,000 women per year; for women age 20 to 44 the incidence was 1.3 cases for 1,000 women per year. These figures include idiopathic and non-idiopathic cases and thus are representative of the general population of nonpregnant women of reproductive age. The incidence of pulmonary embolism was approximately 1 case per 5,000 women age 20 to 44. There were two deaths from pulmonary embolism, giving a mortality rate of 11.3 deaths per million women age 15 to 44.


Aneurysm of the splenic artery associated with fistula between splenic artery and vein.


Acalculous cholecystitis.

Acalculous cholecystitis.


Role of surgery in the treatment of pulmonary tuberculosis. The records of 9939 patients hospitalized for tuberculosis between 1963 and 1972 inclusive were reviewed with respect to patients who were treated surgically. During this period there was a steady decline in the number of patients thus treated; the success of antimicrobial drug therapy has altered the frequency of various surgical procedures, and pulmonary resection is now the procedure of choice, with a growing reluctance to perform segmental resection. Morbidity and complications among the patients in this series have been within acceptable limits. The problem of residual space has been minimal. Bronchopleural fistula with empyema (incidence, 3.1%) has been the most serious complication, accounting for the largest proportion of deaths. The mortality of 2.8% is comparable to that reported in the literature. Though mild to moderate respiratory insufficiency developed in some patients, none was seriously incapacitated. The majority of surviving patients have remained well, with their disease under control. In a number of patients reactivation of the disease occurred, probably because of conservative resection and discontinuance of drug therapy due to misunderstanding between patient and physician.


Angiofollicular lymph node hyperplasia of the lung simulating carcinoma: pseudolymphoma with inflammatory changes. Angiofollicular lymph node hyperplasia of the lung developed in a 45-year-old man who was a heavy smoker. Slow growth of the lesion 3 years after biopsy and the finding of atypical cells in the sputum and bronchial washings strongly suggested a malignant lesion. There were no systemic manifestations other than dyspnea, which may have been related to allergy. The lesion was angiofollicular lymph node hyperplasia of the hyaline-vascular type. Invasion by lymphoid cells of both blood vessels and bronchioles suggested that the pathogenesis was probably infectious or inflammatory; also, the nature of the infiltrate indicated an immune mechanism. The course of the disease, as in other cases reported, has been benign, though a patchy density has developed in contralateral lung 4 years after lobectomy.


Experience with surgical salvage in pulmonary tuberculosis: application to general thoracic surgery. The diminishing incidence of pulmonary tuberculosis and the increasing effectiveness of drug therapy have resulted in an almost complete disappearance of surgical problems in the management of patients with this disease. However, the lessons learned from the management of such problems should not be forgotten, for they are equally applicable to the management of disabling and life-endangering problems in general thoracic surgical practice. "Salvage" situations develop when therapeutic requirements for control of disease are combined with factors affecting a patient's health so as to increase the surgical risk beyond the range usually considered acceptable. Attempts to salvage patients are indicated when treatment has failed to arrest disease, when life expectancy is threatened, or when return to normal activity is imperiled. Risk may be increased because of age, inadequate cardiopulmonary reserve, or chronic toxemia; in tuberculosis, risk may be increased because of positive sputum culture or resistance of organisms. Experience with 146 tuberculous patients has provided a basis for evaluation of the indications for resection, prophylactic and therapeutic thoracoplasty, and closure of bronchopleural fistulas in general thoracic surgical salvage. Both infection in residual spaces and bronchopleural fistulas are serious complications that can be controlled by thoracoplasty and pedicled muscle grafts. Prophylactic use of osteoplastic thoracoplasty and intercostal muscle grafts warrant more serious consideration. In established complications a "tailored" thoracoplasty can also be combined with an intercostal muscle graft.


The Farfan back operation: technique and results. A total of 94 Farfan back operations were performed on 82 patients. As a group these patients were typical of those undergoing discoidectomy, with or without fusion. The follow-up period was from 3 to 5 years. Overall, the results were excellent, good or satisfactory in 85% of the patients; with one-level fusions the proportion of such results was 93%. The commonest cause of failure was extrusion of the bone graft.


Electromyographic and nerve conduction studies in idiopathic ischemic necrosis of the femoral head. Clinical features and results of nerve conduction and electromyographic investigations were studied in 13 consecutive patients with idiopathic ischemic necrosis of the femoral head. Of these patients, one was a diabetic, one had received steroids and six gave a history of high alcohol intake. Neurologic abnormalities were present in 9 of the 13 cases. Specimens were available for examination in the nine patients who underwent operation. This study suggests that disturbance in the neuromuscular system at a clinical or subclinical level could be common to idiopathic ischemic necrosis of the femoral head and its various associated disorders and might be a pathogenetic factor.


Photographic maps for coronary artery operations: how to make them easily. A modification of the Tagarno 35-mm ciné-film projector has been devised primarily for the cardiac surgeon, to produce excellent pictures of opacified coronary arteries. A combined screen and photographic holder allows the surgeon to view an image 10.2 X 12.7 cm and to make positive prints of selected frames in a matter of seconds. No photographic experience is needed.


The Warren (distal splenorenal) shunt for portal hypertension. The Warren distal splenorenal shunt, designed to decompress esophagogastric varices selectively while preserving portal venous inflow to the liver, was performed in 18 patients who had bled from esophageal varices. In 14 cirrhosis was micronodular, in 3 it was macronodular, and in 1 primary biliary. Two patients died within 1 month of surgery (operative mortality, 11%). Three patients died between 2 and 12 months after operation (1-year mortality, 28%). All five patients who died within 1 year had severe liver disease at the time of operation. None sustained further hemorrhage. Only one survivor requires protein restriction and none have fluid retention.


Anorectal and perianal complications of hematologic malignant neoplasms. Among 17 adults with hematologic malignant neoplasms in whom anorectal complications developed, the overall mortality was 53%; for those in whom the disease was not in remission the mortality was 69%, compared with zero for patients who were in remission. All but one of the deaths were directly attributable to septicemia secondary to the anorectal lesion. Over half of the patients had a history of previous anorectal problems or disordered bowel pattern preceding the anorectal complication. The anorectal lesions affecting these 17 patients included prolapsed hemorrhoids (in 5); discrete ulcers in the anal canal and surrounding cellulitis (8); necrosis of the anus and perianal area (2); and perirectal abscesses (2). Only the abscesses responded to surgical drainage. Treatment of the other lesions was conservative: bowel function was maintained as normal as possible, good perineal hygiene was practised and stool softeners were used, while efforts were directed towards achieving remission of the hematologic neoplastic disease.


Clinical aspects of uteroplacental insufficiency.


Tension pneumoperitoneum: case report and review of the literature. Tension pneumoperitoneum in an 81-year-old man resulted from the perforation of an ulcer on the posterior aspect of the first stage of the duodenum into the lesser sac. This condition, though rare, should be considered in the differential diagnosis of the massively distended abdomen. A number of different causes of this condition have been reported, most of which are associated with various diagnostic and therapeutic procedures. Treatment is early laparotomy.


Treatment of fetal growth retardation in utero with heparin and dipyridamole.


Placental insufficiency and postmaturity.


Induction of yolk-sac tumors in the pregnant rat.


Immunogenetic determinants of the size of the fetoplacental unit and their modus operandi.


Maternal blood supply to the coneptus.

Maternal blood supply to the coneptus. This presentation gives an unorthodox account of the relationship of uteroplacental vessels to the structural units of the placenta, the lobules, and its development. Contrary to current opinion, neither the villous stems nor the ostia of maternal arteries have a one-to-one relation to placental lobules. Both are interlobular, and thus supply portions of adjacent lobules. The involvement of whole lobules, usually multiple, in degenerative processes such as infarction as is seen particularly in the placentas of stillborn infants, may indicate a general lowering of perfusion pressure in the intervillous space rather than occlusion of one artery. Just how maternal blood circulates within a lobule, is not known. In visualizing the development of the lobule it is only necessary to realize the commonly observed fact that anchoring points of large villi coming down along the sides of the lobules, are frequently if not regularly associated with the convolutes and ostia of maternal arteries. The areas containing both, form a network; how the intervening areas are formed into lobules is unknown.


Development and ultrastructural adaptations of the human placenta.


Possible functions of nonvillous trophoblast.


Hemodynamic implications of hemochorial placentation.


Buerger's syndrome.

Buerger's syndrome. All cases diagnosed as Buerger's disease at The Mount Sinai Hospital from 1933-1963 have been reviewed. A large majority were found to have well-known vascular problems other than what we now consider as Buerger's disease. Only two specimens from 33 amputations had the characteristic histologic findings that Buerger described. It is suggested that the terminology Buerger's disease be replaced by Buerger's syndrome. In 1908, while at The Mount Sinai Hospital, Dr. Leo Buerger described a clinical entity with its histologic counterpart that soon became known as "Buerger's disease." The clinical picture was essentially that of arterial insufficiency, mainly in the lower extremities, in a young, Jewish, adult male who smoked. It was frequently associated with a migrating thrombophlebitis. The histologic picture was not as clearly defined but was stated to differ from arteriosclerosis in that normal vessel was found proximal and distal to the lesion, canalization of the occlusive lesion occurred, capillary ingrowth was present in the media, and there was an absence of elastic tissue in the organizing process. It should be noted that most of Buerger's specimens consisted of veins removed during an episode of acute thrombophlebitis. He specifically stated that only in the early stages of the disease, when phlebitis was the main finding, could the lesion be separated from the various stages of arteriosclerosis. In recent years, doubt has been cast on the existence of the clinical or pathological picture described by Buerger. Accordingly, it was thought advisable to review the case records and pathologic specimens of patients discharged from The Mount Sinai Hospital with the diagnosis of Buerger's disease over a recent 30-year period.(ABSTRACT TRUNCATED AT 250 WORDS)


Uteroplacental vascular pathology.

Uteroplacental vascular pathology.


The differential diagnosis of congestive cardiomyopathy and ischemic cardiomyopathy by echocardiography.


Cerebral angioma and aneurysm of the cervical internal carotid artery. A case of internal carotid artery aneurysm in association with a congenital cerebral arterio-venous malformation is described. The carotid artery aneurysm was resected with primary anastomosis of the redundant artery, with satisfactory recovery.


The fascicular blocks--their incidence and significance in coronary care unit.


Massive calcification of the myocardium. A case of dystrophic calcification of the myocardium is reported. The clinical, fluoroscopic, hemodynamic and angiographic findings are described, and correlate well with the lesions discovered at surgery. In this case, the diagnosis was originally suspected because of the calcification noted during fluoroscopy.


Cardiac effects of insulin, glucose, and potassium. Glucose-insulin-potassium (G.I.P.) infusions have been recommended as a useful adjunct to the management of severe congestive heart failure. Ten patients with cardiac disease underwent a diagnostic cardiac catheterization. Pressures and cardiac output were obtained prior to and immediately after the 10 minute infusion of a mixture containing 50 grams of glucose, 10 mEq of potassium and 20 units of insulin. (Table: see text). G.I.P. infusions can increase the cardiac index. This is due to a combined effect of volume expansion and catecholamine stimulation.


The cervical aortic arch anomaly.

The cervical aortic arch anomaly. Although the cervical aortic arch anomaly occurs rarely, it should always be considered in the differential diagnosis of pulsatile masses in the neck. The eighteenth case of this anomaly is presented herein. Review of the previous literature demonstrates the consistent pattern of branching anomalies associated with the cervical aortic arch and indicates the complex nature of this anomaly. Studies of these patients in biplane (frontal and lateral), as well as the right posterior oblique projection in order to precisely define the order of branching, is recommended, particularly when surgical intervention is indicated.


Acute fragility of cerebral blood vessels in hepatic coma.


Non-invasive techniques in the evaluation of the patient with coronary heart disease.


Termination of atrial flutter and atrial tachycardia with rapid atrial stimulation. The results in this series of fifty-seven patients confirms the safety and reliability of rapid atrial stimulation to terminate atrial flutter and atrial tachycardia. Transthoracic wires implanted at thoracotomy or transvenously placed atrial electrodes can be used for the confident intracardiac electrocardiographic diagnosis of tachyarrhythmias and for atrial stimulation. Our experience represents the second largest reported series of patients to undergo cardioversion by this method. In all but five of fifty-seven patients either the atrial tachyarrhythmia was converted to normal sinus rhythm or the flutter-tachycardia was terminated with resultant atrial fibrillation. In forty-three patients sinus rhythm was eventually re-established after atrial stimulation. Various aspects of rapid atrial stimulation, including it's preference over precordial shock, have been discussed. We feel particular consideration should be given cardioversion by rapid atrial stimulation in patients with possible digitalis toxicity and in all patients who have atrial flutter, atrial tachycardia, or junctional tachycardia after open heart surgery.


Exertion and acute coronary artery injury. Twelve cases of myocardial infarction as related to strenuous exertion are presented with the pathological findings in several of these cases. Three cases with coronary arteriography are also presented. The pathology of coronary arteriosclerotic plaques and the vulnerability to acute injury is reviewed and discussed. It is concluded that strenuous exertion can cause acute injury to coronary artery plaques due to the unusual stressful whip-like action to which coronary arteries are subject. These injuries may initiate as cracks in the plaques or subintimal hemorrhages and proceed to coronary occlusion and ultimate myocardial infarction. With this concept in mind we use the term of "crack in the plaque" (Black's Crack in the Plaque) to account for the sudden appearance of clinical coronary artery disease appearing during or shortly after exertion, or other stressful situations in patients without previous existing evidence of clinical coronary artery disease. This could also account for exacerbation of symptoms or death occurring after exertion in previously quiescent asymptomatic known coronary artery disease subjects. This concept may explain some of the puzzling features of coronary disease.


The role of angiography in the management of intestinal carcinoid. Carcinoid tumors of the intestine may present with bowel obstruction or with the carcinoid syndrome. Confirmation of the diagnosis by biochemical means is easy. Management is often surgical and a number of different procedures have been advocated, e.g. resection of the primary, hemicolectomy and lately, partial hepatectomy. The angiographic features of two cases are presented and discussed; the usefulness of the information so gleaned in the choice of management is stressed.


Therapeutic aspects of hypertension.

Therapeutic aspects of hypertension.


Effect of papaverine hydrochloride on cerebral blood flow as measured by forehead thermograms. Using the atraumatic diagnostic technique of forehead thermography to indirectly evaluate cerebral arterial circulation, nine patients with vascular disease in the extracranial or intracranial carotid arterial system were given 300 mg. papaverine hydrochloride. All patients demonstrated some degree of improvement after the drug was administered as determined by comparing control thermograms to thermograms obtained 1, 4 and 8 hours after administration of the drug. Improvement was attributed to increased cerebral blood flow due to the direct vasodilating effect of papaverine hydrochloride. In conclusion, this study suggests that if potential stroke victims can be detected at an early stage with thermography (and/or with other atraumatic diagnostic techniques), drug therapy may prove to be of immediate therapeutic value. The response of any given patient to drug therapy may be determined simply and atraumatically by thermographic examinations in which each patient is used as his own control.


The effect of propranolol and verapamil on atrial and atrioventricular refractory periods in man. The atrial effective (ERP) and relative (RRP) refractory periods were examined at high atrial pacing rates in 12 patients before and after intravenous injection of propranolol, and in 5 patients before and after injection of verapamil, using the technique of paired pacing. Seven of the patients had A-V block grade II-III and 10 patients had sinus rhythm. The range of atrial ERP in all patients was found to be 200 to 270 msec. and the range of atrial RRP was 230 to 330 msec. The atrial ERP and RRP were longer at a pacing rate of 160 per minute than at a pacing rate of 240 per minute. The conduction delay between the second impulse and the atrial depolarization was found to be due to increased interval between the stimulus and the start of the depolarization wave. The atrial ERP increased after injection of propranolol in 8 of 12 patients, decreased in 3 patients and was unchanged in one patient. The atrial RRP increased in 7 patients, decreased in one patient and was unchanged in 4 patients. In all patients the changes were of moderate degree. The conduction delay between the stimulating impulse and the atrial response was shorter after propranolol in 7 patients, longer in one patient and unchanged in 4 patients. The ERP of the atrioventricular conducting tissue was 220 to more than 380 millisec. After injection of propranolol it increased in all of 3 patients in whom it could be measured. After injection of verapamil no significant effects on the atrial ERP and RRP were found. ERP of the atrioventricular conducting tissue was lengthened in 4 of 5 patients, and the degree of A-V block during rapid atrial pacing increased after injection of verapamil. It is suggested that the effect of propranolol on atrial arrhythmias is due to its effect on ectopic pacemaker activity rather than any effect on the refractory period of the atrium. The effects of verapamil on the atrioventricular conducting tissue may explain some of the antiarrhythmic effects of this drug.


Changes in enzyme levels in human skeletal muscle during obstructive arteriopathy of the lower limbs. Some enzymatic activities have been assayed in the gastrocnemius muscle of patients with obstructive arteriopathy of the lower limbs. The specific activities of all the examined glycolytic enzymes, of malate dehydrogenase and of glycerol-3-phosphate dehydrogenase are significantly decreased while the specific activities of two lysosomal enzymes, beta-glucuronidase and cathepsin A, are significantly higher than in the controls. Therefore it may be inferred that the metabolic capacity of glycolysis and of Krebs cycle are lowered. On the other hand the increased specific activity of lysosomal enzymes suggests the hypothesis that the above mentioned modifications and the morphologic alterations of the muscle and of the small blood vessels might be ascribed, at least partly, to a release of lysosomal hydrolases in active form.


Thrombolytic treatment with i.v. brinase of advanced arterial obliterative disease of the limbs. The material includes 17 patients suffering from different degrees of chronic peripheral arterial disease (11 chronic patients stage III and IV, two patients with acute arterial occlusion, and four patients stage II). Presence and extent of arterial occlusion was ascertained by initial arteriography. In twelve of the patients amputation had been considered. The patients were treated by a series of i.v. infusions of brinase, a proteolytic enzyme from Aspergillus oryzae. The brinase inhibitor capacity in plasma was determined by the azocollagen technique. Dosage of brinase was calculated to retain a rest-inhibitor capacity in order to avoid free proteolytic activity. In five patients the enzyme was also given preoperatively by intra-arterial instillation prior to a series of i.v. brinase infusions. Thirteen patients showed clinical improvement after brinase treatment. The condition of two patients remained unchanged, and in two patients amputation could not be avoided. In fourteen patients the treatment results were followed by measurement of peripheral systolic blood pressure. In ten patients obvious increase of the peripheral systolic blood pressure was observed. Cutaneous microcirculation was studied in seven patients by i.v. sequential fluorescein angiography and signs of improved microcirculation (appearance time, intensity and/or extent of fluorescence) were found in all examined patients. One patient with acute arterial occlusion of the right leg with obstruction of blood flow from the external iliac artery showed complete disobliteration after a series of i.v. brinase infusions. Bleeding complications associated with brinase treatment were not observed in the material. In three patients brinase treatment was discontinued because of complications (2 brinase, 1 heparin).


Coronary artery-pulmonary artery communication.


The effect of phentolamine on conduction in the bundle of His. A His bundle electrogram was obtained in a 65 year old male with syncopal episodes. A split bundle of His deflection was recorded. After the intravenous administration of phentolamine, a marked shortening of the H-H' interval was observed. This signifies an improvement in conduction at the bundle of His level.


Surgical relief for premature closure of fontanelles due to cerebral angioma--a case report.


Mesenteric thrombosis associated with oral contraceptives.


Dosage titration with furosemide in congestive heart failure patients. Clinical status and diuretic requirements of a group of congestive heart failure patients were re-evaluated. A group of 115 congestive heart failure patients were hospitalized, given a comprehensive medical examination and treated with placebo for four weeks. Thirteen patients did not exhibit signs and symptoms of congestive heart failure during this phase. The remaining 102 patients were treated with 40 mg furosemide per day for a second 4-week period. Fifty-three required 80-120 mg furosemide per day and 49 were successfully controlled at 40 mg per day. Ten patients dropped out voluntarily and 39 were controlled for an additional four weeks at a dose of 20 mg bid furosemide. In the final phase, dosage was lowered to 20 mg per day and 24 of the 39 patients, (62%), were successfully controlled for four weeks, while 14, (36%), were controlled for eight weeks. Results of this study suggest that a number of congestive heart failure patients can be controlled with relatively low doses of furosemide and that there is a need for periodic re-evaluation of the clinical status and diuretic requirements of patients on maintenance therapy.


The efficacy of five per cent oxyphenbutazone cream in the treatment of venous eczema of the leg.


Lymphedema: patho-physiologic and clinical concepts.


Small vessel reconstructive surgery of the lower extremities.


The single dose method of administering cholestyramine. A new and simplified method for the administration of cholestyramine is presented. It has been our finding that the total daily dose of the resin (as indicated below) may be administered once a day in a single dose at any time during the waking hours, without reference to meals, and the resulting degree of cholesterol lowering is as great or greater than that obtained by the same dose with the traditional method of t.i.d. administration of cholestyramine. Doses of 12 or 16 gm per day, have been administered as a single dose to adult patients. We have not encountered side effects from the administration of this resin as a single dose, however an occasional patient has objected to the volume involved, and has preferred to take a smaller volume 2 or 3 times daily. Because of the bulk involved in the administration of larger doses, we have found it expedient to give doses of 24 gms per day by dividing the dose in half and administering it twice daily without reference to meals. The 21 patients in our study who received cholestyramine in the single daily dose obtained an average reduction of their serum cholesterol of 21.58% over baseline values. Twenty patients receiving a somewhat larger dose, administered twice daily (b.i.d. dose), obtained a 27.57% reduction in the serum cholesterol, and out of this entire series there were 22 patients who had at other times received the cholestyramine by the t.i.d. regimen. They had obtained a 25.61% reduction of their serum cholesterol (by the t.i.d. regimen). All 3 average percent reductions compared to 0 are highly significant (p is less than 0.0001). One hundred forty out-patients treated by the conventional t.i.d. program of administration obtained a 16.8% reduction in the serum cholesterol. This includes some patients taking relatively small and less effective doses. Our entire series of 238 patients (to be reported subsequently) treated as out-patients have obtained an average reduction of 22% of their serum cholesterols. There has been no statistically significant influence on the levels of the serum triglycerides during cholestyramine therapy in this series (results on 69 patients showed an average rise of 5.9 mg per 100 ml in the serum triglycerides). See discussion in text. Some studies have indicated a rise of serum triglycerides during cholestyramine therapy. It is recommended that triglycerides be monitored periodically during the course of cholestyramine treatment.(ABSTRACT TRUNCATED AT 400 WORDS)


Traumatic subclavian arteriovenous fistulae. Arteriovenous (A-V) fistulae can be congenital or acquired. Acquired arteriovenous fistulae are met with during war as well as civilian practice as a result of penetrating injuries causing perforation in an artery and a vein which are surrounded usually by a firm sheath like the femoral, carotid or subclavian sheath, resulting in a communication between the artery and the vein. In the past, these fistulae were treated either by ligation of the feeding artery or by quadruple ligation after waiting for the collateral circulation to develop and feed the affected limb. The goal of the modern vascular surgeon, however, is to resume vascular continuity of both artery and vein. We were recently faced with a subclavian arteriovenous fistula and aneurysm caused by a gunshot wound of many years' duration. Searching the literature on a detailed technique for complete repair of such a fistula proved fruitless. Hence, we were thrown upon our own resources. We planned this operation which proved safe and successful. Repair of a subclavian arteriovenous fistula is a challenging piece of surgery. The location of this fistula under the clavical and its proximity and connection to important structures in the neck and the thoracic outlet makes its correction difficult and hazardous. The purpose of this paper is to present this method of safe repair and discuss the pitfalls and safeguards.


A simple method to detect defects in circuitry of bipolar pacing electrodes.


Recanalization of the patent ductus arteriosus: report of an interesting case.


A reappraisal of the clinical diagnosis of postoperative deep vein thrombosis.


Combined thoracic aorta and right carotid artery angiography in trauma. In the critically injured patient, time is of the essence; a method is described for performing a thoracic aortogram for possible ruptured aorta, followed by a right carotid cerebral angiogram as a screening procedure to rule out cerebral vascular shift, using the pigtail catheter.


The problems of vascular access for hemodialysis in juvenile diabetics with end-stage renal disease.


Dosage of i.v. brinase in man based on brinase inhibitor capacity and coagulation studies. In 17 patients a total of 148 brinase infusions were given. All patients but two had anticoagulant treatment (dicoumarol or heparin) during the brinase series. Dosage of brinase was based on determination of brinase inhibitor capacity in plasma (azocollagen technique) prior to infusion of the enzyme. Iv infusion of brinase lowered inhibitors in plasma. Good correlation was found between expected lowering and measured inhibitor values after brinase infusion. The stipulated safety margin for brinase inhibitor capacity could be maintained. alpha 1-antitrypsin showed irregular changes and alpha 2-macroglobulin values were decreased by iv infusions of brinase. Fibrinogen values were somewhat lowered after iv brinase infusion. Values for fibrinogen degradation products increased and the ethanol gelation test became positive. Thrombotest values were lowered and the activated partial thromboplastin time was prolonged in patients receiving dicoumarol and iv heparin respectively. Changes in other coagulation parameters were insignificant. In two patients transient renal failure was recorded, laboratory data indicated intravascular coagulation as a possible cause. None of these two patients were on anticoagulant treatment. One patient developed a haematoma of the forefoot during massive iv heparin treatment during a series of iv infusions of brinase. Bleeding complications due to brinase treatment were not observed.


Arteriointestinal fistula: report of a case following surgery for trauma. A case of an arteriointestinal fistula following surgery for trauma is reported. In prevention of this complication, it is suggested that temporary ileostomy and mucous fistula be considered in cases of combined right colon and intra-abdominal vascular injuries to eliminate a leaking bowel anastomosis as a source of contamination of the vascular repair.


Editorial: Has the annual session outgrown its format?


Dental auxiliaries, universities, and academic freedom. The practicing dental profession lately has asked questions regarding the propriety of research programs designed to investigate the use of expanded duty dental auxiliaries. The dental schools see paraprofessional research as socially responsive. Dental societies recognize the usefulness of auxiliaries but feel their responsibilities should be limited. This paper examines the status of dental auxiliaries, universities, and academic freedom.


Close-up photography in the dental office. Photographs taken by the dentist can be used in his professional contacts, in office administration, and for patient education and motivation. The parts of a camera including viewing systems, lenses, shutters, diaphragm, and film are described. The technique for close-up, intraoral photography requires special lens systems and proper lighting. The correct method for focusing is described.


Nonfatal anaphylaxis caused by oral penicillin: report of case. Severe allergic reactions may occur after the ingestion of oral penicillin. It is essential that the dentist who prescribes the drug is familiar with the rationale for therapy and is equipped to initiate urgently needed treatment.


Recommendations in radiographic practices, January 1975. Council on Dental Materials and Devices.


Certification program for dental materials: list of certified dental materials and devices revised to Jan 1, 1975. Council on Dental Materials and Devices.


Use of acid cleanser in endodontic therapy. The use of a 50percent citric acid cleanser in root canals after pulpectomy produced well-cleaned surfaces as shown by scanning electron microscopy. Compared with other cleaning agents, this cleanser provided improved penetration of rosin into the dentinal tubules and better wall adaptation of gutta-percha. No contraindication has been encountered in clinical practice. Application of the cleanser directly to the exposed pulp resulted in satisfactory destruction similar to the results obtained with strong acids.


List of classified dental materials and devices revised to Jan 1, 1975. Council on Dental Materials and Devices.


Mortality of dentists, 1968 to 1972. Bureau of Economic Research and Statistics.


An esthetic transitional treatment for amelogenesis imperfecta: report of two cases. The literature pertaining to amelogenesis imperfecta is reviewed as it applies specificity to two reports of cases. Psychologic, mechanical, or economic factors may warrant a transitional treatment of the teeth. Treatment with the use of an etchant and composite material and glaze is described.


American Dental Association principles of ethics with official advisory opinions as revised.


Course listing for January through June 1975. Bureau of Dental Society Services. Council on Dental Education.


Held hostage!

Held hostage!


Lists of products evaluated by the Council on Dental Materials and Devices and the Council on Dental Therapeutics.


Letter: That reciprocity problem.

Letter: That reciprocity problem.


Letter: A 'second' diagnosis.

Letter: A 'second' diagnosis.


Letter: On dues increase.

Letter: On dues increase.


Letter: Dental fee indicator.

Letter: Dental fee indicator.


Letter: Problems of supply.

Letter: Problems of supply.


Letter: Responds to editorial.

Letter: Responds to editorial.


Letter: The oral cavity.

Letter: The oral cavity.


Duration of amnesia during sedation with diazepam and pentazocine: preliminary report. Fifteen student volunteers participated in a study to determine the duration of amnesia obtained with diazepam and with pentazocine. The group that received pentazocine experienced only slight sedation and no amnesia. There was extreme variance in the level of sedation and in the incidence and duration of amnesia in the group that received diazepam. When amnesia occurred, it lasted for an average of 24 minutes. All students in the group that received a combination of diazepam and pentazocine were well sedated; the average duration of amnesia was 25 minutes.


Letter: Dental insurance 'costs'.

Letter: Dental insurance 'costs'.


Fenestrated palatal mucosal grafts for vestibuloplasty. Vestibuloplasties with fenestrated palatal mucosal grafts were successful in eight patients. The fenestrated palatal mucosa provides a tough, full-thickness, resilient mucosal graft from a limited donor site. The operating time is decreased, bleeding is minimized, and healing time of the donor site is shortened. Fenestration allows seepage of blood and tissue fluids from beneath the graft. The fenestrated grafts are readily adaptable to any irregularities of the edentulous mandibular ridge.


Clinical-pathological conference: Case 10, part 2. Neurofibrosarcoma.


Metastatic lesions to the oral soft tissues.


Letter: Problems with jaw fixation for weight control.


Complex odontoma of the maxillary sinus: report of case. During a screening examination for orthodontic evaluation and for possible partial anodontia, a large radiopaque mass was found in the right maxillary sinus of a 12-year-old boy. Further radiographic views were used to locate and establish a working diagnosis. The mass was removed with use of a standard Caldwell-Luc approach. It was diagnosed histologically as a complex odontoma.


Letter: Support for board recertification.


Malignant hyperthermia.

Malignant hyperthermia. Malignant hyperthermia is a genetic disease that may become apparent after exposure to drugs; some of these drugs are commonly used by the oral surgeon. One in 14,000 young, apparently health individuals may be affected; mortality is 64 percent. Many cases of malignant hyperthermia can be prevented if an adequate history is obtained. Oral surgeons should be familiar with the prevention, diagnosis, and initial treatment of malignant hyperthermia.


Simplified technique to reduce perioral edema in intraoral sagittal split osteotomies. A simplified technique has been developed for the prevention of the severe perioral edema that is routinely associated with intraoral sagittal split osteotomies of the ascending ramus of the mandible. By the use of gauze sutured through the cheeks in the region of the oral commissures, trauma caused by retraction of instruments is significantly diminished.


Periadenitis mucosa necrotica recurrens. A review of the literature and a case report of PMNR that lasted more than 20 years is presented. The previously unreported use of large doses of erythromycin taken orally as a treatment alternative is offered.


Editorial: Fulfilling our obligation as doctors.


Letter: Multiple myeloma.

Letter: Multiple myeloma.


The DSSNY malpractice insurance program.


The non-parallel pin splinting system.

The non-parallel pin splinting system.


Sipple syndrome and acute lymphoblastic leukemia.


Long-term effect of benzene in C57BL/6N mice. Weaning male C57BL/6N mice received repeated subcutaneous injections of benzene in corn oil for 54 weeks. These mice and surviving controls were killed 104 weeks after the first injection. There was no evidence of carcinogenic activity in benzene-injected mice. A high incidence of amyloidosis developed in  mice of all treated and untreated groups. Butyinitrosourea, used as a positive control, induced lymphomas or leukemias (in most exposed mice) and intestinal tumors in a few.


Conservative treatment of bilaterally dislocated mandibular condyles.


Letter: Reciprocity continued.

Letter: Reciprocity continued.


Letter: Endosseous implant agreement.

Letter: Endosseous implant agreement.


Editorial: The ADA public education program--a 1975 harbinger of joy?


Primary malignant hemangioendothelioma of the gingiva. Report of a case and review of the literature. Primary malignant tumors of vascular origin are exceedingly rare in the oral cavity. Consequently, knowledge of their clinical and pathologic features is scanty. The varied array of terms applied to malignant vascular tumors has only further confused the issue. This article presents a review of twenty examples of oral malignant vascular tumors, with a report of a single personally studied case. Specifically, this case presented as a soft-tissue gingival lesion which subsequently invaded bone and represents a malignant hemangioendothelioma.


Letter: Avanti G. P.

Letter: Avanti G. P.


Migratory glossitis. A clinical-histologic review of seventy cases. The observations on seventy patients with migratory glossitis and follow-up experiences over a period of 10 years are recorded. Women represented 65.7 per cent of the total, and most cases occurred in patients over 40 years of age. In 20 per cent of the patients other anomalies of the tongue were associated, and in 20 per cent subjective complaints were associated with psychic stress. Histologic investigations showed an inflammatory reaction of the epithelium and of the underlying connective tissue. The patient must be reassured of the benign nature of the tongue lesion. At follow-up examination, the lesions were present but no malignant change was observed.


Studies on oral lichen planus. III. Clinical and histologic correlations in 213 patients. Two hundred thirteen adults in whom oral lichen planus had been diagnosed were studied in order to compare clinical and microscopic findings. In spite of considerable variabilities in both aspects, there was clinical and histologic agreement in 96 per cent. Alertness on the part of the clinician and pathologist is essential for diagnosis of atypical cases.


Dental pulp histology observed by scanning electron microscopy. This article describes the appearance of routine decalcified and paraffin-embedded histologic sections of the human dental pulp as observed with the scanning electron microscope (SEM). The tissue sections were cut at 12 mum in order to increase the three-dimensional effect. The technique was particularly successful in revealing the three-dimensional structure of pulpal blood vessels and nervous tissue. Possible interodontoblastic attachments were revealed at x10,000.


Developmental submandibular gland defect of the mandible. Review of the literature and report of a case. The literature relative to developmental submandibular gland defect of the mandible is reviewed, and an interesting case is presented. Evaluation for more serious systemic disease which may manifest radiolucencies in the region of the angle of the mandible is made.


Compact foreign-made dental x-ray generators: an evaluation of their acceptability for effective dental radiography. II. Image characteristics and observer performance. Imported generators, while inexpensive and compact, feature fixed peak kilovoltage and fixed milliamperage levels. These generators, because of the relative inflexibility of their operating characteristics, cannot be modified to produce radiographic image characteristics of equal diagnostic value to the domestic generators without compromises which are unacceptable.


Conservation of human research teeth by controlling cavity depth. In order for the dental profession to obtain reliable data as to whether new or experimental restorative materials and adjunct agents are more or less irritating to pulp tissues than dental products currently in use, pulp studies at the national and international level are being standardized to enhance corroboration. The purpose of this study was to reduce the number of human teeth required in any experimental pulp toxicity study by controlling the problem of cavity depth. Many valuable teeth are wasted by making cavity preparations that are either too shallow or too deep, with consequent pulp exposures. This needs to be corrected.


The storage of teeth before reimplantation in monkeys. A histologic study. This study is a histologic comparison of twenty teeth which were extracted, endodontically treated, stored for 7 days at +4 degrees C. and at -10 degrees C., and subsequently reimplanted in ten monkeys. In these monkeys, as controls, ten more teeth were extracted, endodontically treated, and immediately reimplanted. Up to 1 year, 100 per cent success was obtained in those teeth stored at +4 degrees C. before reimplantation, and only 50 per cent success was obtained in those teeth stored at -10 degrees C. before reimplantation.


Application of a lateral compression clamp in the management of mandibular fractures. A lateral compression clamp system has been used in the treatment of fractures of the mandible. It provides rigid fixation and promotes earlier osteogenesis at the fracture site. Intermaxillary fixation can often be eliminated in edentulous persons and greatly reduced in duration when necessary as an adjunct to fixation in patients with teeth. These significant qualities make the compression clamp quite beneficial in the treatment plan and postoperative management of many otherwise difficult cases. Having evaluated our experiences with compression clamps, we believe that this approach deserves further attention and may contribute to a solution of the controversy that often exists regarding the management of mandibular fractures in both edentulous patients and those with a compromised complement of teeth.


Metastatic renal adenocarcinoma presenting as periapical pathosis in the maxilla. A case is reported because of the infrequency with which tumors metastasize from the kidney to the maxilla. It is of special interest because it presented as a periapical pathosis associated with a nonvital tooth and emphasizes the value of routine histopathologic examination of tissue.


Congenital midline fistula of the tongue. A possibly unknown entity of congenital midline fistula of the tongue, hitherto not mentioned in the literature, is reported. The embryologic basis of it is explained and the role of the tuberculum impar in the development of the anterior two thirds of the tongue is discussed.


Tardive dyskinesia. A significant syndrome for geriatric dentistry.


Requirements for anesthesia: local anesthesia.


An experimental study of intraoral carcinogenesis in rats. A new method has been devised for preparing artificial cecal pouches lined with mucous epithelium in the lower lips of Wistar and Sprague-Dawley rats in order to make carcinogens act continuously for a long time in the oral mucosa. When a 0.5 per cent mineral oil solution of DMBA, a crystal of MC, and a crystal of NG were administered, squamous-cell carcinoma, carcinoma in situ, papilloma, adenoma sebaceum. neurofibroma, fibroma, hemangiosarcoma, hemangiosarcoma, hemangioma, and lymphangioma were successfully produced in the oral mucosa of rats. In addition, interesting findings were obtained concerning tissue changes in the process of carcinogensis in the mucous epithelium.


Lingual osseous choristoma. Report of two cases. The lingual osseous choristoma is a rare benign lesion of the tongue, and it is difficult to make a correct preoperative diagnosis of these lesions. Two cases are presented in this article.


Temporomandibular joint arthroplasty with fascia lata. Two patients with temporomandibular joint arthralgia and ankylosis were managed with arthroplasty and insertion of fascia lata. The role of physiotherapy, chances of facial nerve damage, role of steroids, and advantages of fascia lata are discussed.


The effect of high cervical cordotomy on portal vein plasma serotonin and 5-hydroxyindoleacetic acid levels in dogs with and without superior mesenteric artery occlusion. In ten dogs undergoing high cervical cardotomy, there was a statistically significant fall in plasma serotonin (5-HT) levels in portal vein blood; no further change in plasma 5-HT occurred after superior mesenteric artery (SMA) occlusion, which is an effective stimulus for 5-HT release. In five dogs undergoing high cervical corotomy with no SMA occlusion, there was a comparable fall in portal vein plasma 5-HT levels. The 5-hydroxyindoleacetic acid (5-HIAA) values in portal vein blood in the two groups of dogs above fell to comparable levels. These findings  indicate (1) that maintenance of the normal plasma 5-HT level in portal vein blood in this experimental model is dependent on the integrity of the spinal cord and (2) that SMA occlusion in animals with a high cervical cordotomy does not result in further changes in the plasma 5-HT level in portal vein blood.


The case for general anesthesia.

The case for general anesthesia.


Purinylhydantoins. Facile conversion of the naturally occurring N-(purin-6-ylcarbamoyl)-L-amino acids into 3-pruin-6-ylhydantoins and 3-cyclohexyl-1-(purin-6-ylcarbamoyl)hydantoins. The naturally occurring N-(purin-6-ylcarbamoyl)-L-threonine (PCT, 1b), N-(purin-6-ylcarbamoyl)glycine (PCG, 1a), and some of their analogs were converted into novel purine derivatives, the purinylhydantoins. The PCT and PCG underwent intramolecular cyclization in the presence of N,N-dicyclohexylcarbodiimide (CDD) to give the 3-purin-6-ylhydantoins (2a-c). The same hydantoins were also obtained when the PCT and PCG were allowed to react through the mixed anhydride formed from cyclohexyl isocyanate or ethyl chloroformate. 1,3-Dicyclohexyl-1-(N-(purin-6-ylcarbamoyl)aminoacyl)ureas 3a and 3c, by-products obtained from the DCC reaction, were rapidly converted in aqueous NaOH to another type of purinylhydantoins, the 3-cyclohexyl-1-(purin-6-ylcarbamoyl)hydantoins 4a and 4b. Compound 4a when heated in base underwent hydrolysis of the hydantoin ring giving biuret N-(cyclohexylcarbamoyl)-N-(purin-6-ylcarbamoyl)glycine (5a) and N-(purin-6-ylcarbamoyl)glycine cyclohexylamide (6a). The characterization of these hydantoins was carried out by uv, nmr, and mass spectrometry. The 3-purin-6-ylhydantoins and 3-cyclohexyl-1-(purin-6-ylcarbamoyl)hydantoins showed growth inhibitory activity in the cultured leukemic cells, while the parent amino acid compounds were inactive.


Anesthesia for surgery of strabismus.

Anesthesia for surgery of strabismus.


Suggested criteria for the evaluation of physicians in family practice.


Three psychobiological paths toward death: cardiovascular disease, tuberculosis, and cancer.


Anesthesia and intraocular pressure.

Anesthesia and intraocular pressure.


Cancer of the lung in males.

Cancer of the lung in males.


Hypofibrinogenemia associated with vincristine and prednisone therapy in lymphoblastic leukemia. Three patients with acute lymphoblastic leukemia and one with lymphosarcoma cell leukemia developed transient hypofibrinogenemia during a course of treatment with vincristine and prednisone. There was no evidence of overt, disseminated intravascular coagulation or significant liver impairment. Fibrinogen survival using homologous-125-I-labelled fibrinogen was measured in two patients; it was moderately shortened in both, perhaps indicating subclinical intravascular coagulation. Rapid lysis of leukemic cells might have been responsible for activating coagulation and fibrinolysis in vivo. These four patients, however, were not different in any clinical or laboratory parameter from nine others with lymphoblastic leukemia similarly treated and investigated without observing any defect in their fibrinogen. There were no bleeding complications and the fibrinogen level became normal within 13 to 30 days.


Total body irradiation (TBI) as primary therapy for advanced lymphosarcoma. The natural history of lymphocytic lymphomas is such that diffuse involvement usually is present at diagnosis. Extensive lymphatic irradiation with tumoricidal doses is seldom an appropriate form of treatment, as most patients require systemic therapy. We have investigated total body irradiation (TBI) as an alternative to chemotherapy. A series of 39 consecutive untreated patients with generalized disease is reviewed. Actuarial 5-year survival rates for the well-differentiated, poorly differentiated nodular, and poorly differentiated diffuse histologic types are 100%, 78%, and 56% respectively. The single major complication, acute myelocytic leukemia, has developed in 2 of the 8 patients given extensive nodal irradiation as a supplement to TBI. None of the 31 patients receiving only TBI as initial therapy has shown evidence of a myeloproliferative disorder to date.


Cell density-dependent growth in agar of bone marrow cells from tumor-bearing BALB/c mice in the absence of a colony-stimulating factor. Bone marrow cells from BALB/c mice with myeloid leukemia, lymphosarcoma, erythroblastosis, or mammary tumor produce small clusters in semisolid agar cultures in the absence of specific colony-stimulating factor. This spontaneous growth is observed only when high cell numbers (5 x 10 5 cells/ml) are plated. The phenomenon was encountered only when mice had an elevated number of mature or immature granulocytes in the peripheral blood. Removal of the adherent cells from the bone marrow did not abolish spontaneous growth, indicating that this colony-stimulating factor independency is not due to a high number of colony-stimulating cells in the bone marrow cells. This excluded the possibility that the spontaneous growth was due to a high endogenous stimulating activity of the bone marrow from tumor-bearing mice.


Decreased lymphocyte adenosine deaminase activity in acute lymphocytic leukemia children and their parents. Adenosine deaminase has been measured in the lymphocytes of children with acute lymphocytic leukemia and in those of their parents. The activity was found to be significantly lower in both acute lymphocytic leukemia children in remission and relapse and in the parents of acute lymphocytic leukemia children when compared with normal adults and children of similar ages.


Combined modality therapy of acute lymphocytic leukemia. The progressive improvement in the prognosis of acute lymphocytic leukemia has been a result of two major developments: 1) the more efficient use of chemotherapeutic agents, particularly the use of combinations of agents and the discovery that agents effective at one stage of disease may be inappropriate at another stage, and 2) the prevention with irradiation of central nervous system relapse. As many as one-half of children with this disease may enjoy long-term leukemia-free survival. However, further studies are needed to improve the efficacy and reduce the toxicity of therapy. This paper reviews the evolution of some of these studies.


Inhibition by 4'-demethyl-epipodophyllotoxin 9-(4,6-O-2-thenylidene-beta-D-glucopyranoside) of human lymphoblast cultures in G2 phase of the cell cycle. 4'-Demethyl-epipodophyllotoxin 9-(4,6-0-2-thenylidene-beta-D-glucopyranoside) is a semisynthetic derivative of podophyllotoxin with oncolytic activity against a variety of neoplasms, Unlike the parent compound and other derivatives, which cause methaphase arrest, 4'-Demethyl-epipodophyllotoxin 9-(4,6-0-2-thenylidene-beta-D-glucopyranoside) apparently blocks the entry of CCRF-CEM cells into mitosis by inhibiting cells in the G2 phase of the cell cycle. The inhibition of precursor incorporation into DNA, RNA, and the protein, if observed, was delayed and probably secondary to inhibition of cells in the G2 phase of the cell cycle.


Alterations in ribonuclease activities in the plasma, spleen, and thymus of tumor-bearing mice. Six transplantable murine tumor models were evaluated for changes in RNase activity. This study was conducted with spleen and thymus homogenates, as well as with plasma collected from tumor-bearing mice. Nuclease activity directed against the synthetic substrates, polyadenylic acid, polyuridylic acid, and polycytidylic acid, was measured and the data obtained for tumor-bearing animals were compared to their normal counterparts. Elevated activity against polyuridylic acid was observed in the plasma of all tumor-bearing mice. Although not as all inclusive, RNase levels in both the spleen and thymus were generally altered as well. The observance of unilateral changes in nuclease activity directed against the synthetic substrates demonstrated that, in most cases, two or more enzymes were being detected. The assay may have some eventual value in the monitoring of cancer


Gilles de la Tourette's syndrome and depression: a case report.


Symposium on Genetics: Foreward.

Symposium on Genetics: Foreward.


Genetic effects of radiation.

Genetic effects of radiation. The effects of radiation on biologic systems as manifested through genetic changes have been reviewed. The use of x-radiation by the health professions represents the largest contribution of radiation dose to the people of the United States. It is apparent that the genetic effect of radiation results in the production of chromosomal aberrations and gene mutations. Recognizing this, it becomes mandatory that appropriate measures are instituted to reduce to an absolute minimum the total amount of radiation that patients receive. Strict utilization of all known protective measures and adherence to protective guidelines promulgated by the ICRP and NCRP IS IMPERATIVE. Every attempt must be made to obtain maximal diagnostic yield from all radiation exposures used for diagnostic purposes, thereby assuring maximal benefit for our patients with minimal risk to our ancestors.


Gene-environment interactions during tooth development. The nature of the interaction between the environment and the genetic information of the organism has been examined vis-a-vis the local tissue environments in which the teeth are initiated. The directive role of the dental connective tissue, the papilla, and sac in initiating the tooth bud, controlling its shape, and maintaining its differentiation emphasize the importance of the mesenchymal connective tissue elements of tooth buds. The molecular character of this tissue interaction was described and the role of collagen as a mediator of developmental information was stressed. Finally these data from experimental studies suggest that the etiology of ectodermal dysplasia and inherited diseases involving the dentition may involve the function of the connective tissue of the dintition.


Genetic factors in the growth of the head. Inheritance of the craniofacial complex and malocclusion.


Dental variation among populations. An anthropologic view. There is considerable variation between and within populations with regard to tooth size, age of eruption, congenitally missing teeth, and crown morphology. These differences are a reflection of the ongoing process of evolution. The genetic basis for this variation is best explained by a polygenic model of inheritance. Even though tooth morpholoyg and agenesis have discontinuous distributions - usually evidence of single gene transmission - they are also  polygenic traits and are examples of "quasi-continuous" characteristics. These are traits which exhibit phenotypic discontinuity at the end of a continuous distribution. Postnatal conditions such as nutrition, disease, or climate seem to have little influence on normal dental variation. Most of the environmental factors which affect the dentition occur during the prenatal period. In particular the quality of the intrauterine environment appears to be most important. This suggests that good prenatal nutrition and medical care are needed for a normal and healthy dentition.


Genetics of cleft lip and cleft palate.

Genetics of cleft lip and cleft palate.


Histocompatibility genes and tooth transplantations.


Teratogenic effects of environmental agents on embryonic development.


Genetic counseling in dentistry.

Genetic counseling in dentistry.


Genetics of common dental disorders.

Genetics of common dental disorders.


Task force report on the future of the CDA.


Effectiveness of a newspaper column in dental education.


Where is society's lack of consensus leading?


Federal income tax returns by dentists.

Federal income tax returns by dentists.


Hodgkin's disease complicated by acute leukaemia.


Oral manifestations of the hemoglobinopathies.


Periodontal significance of cervical enamel projections.


Distribution and natural history of carious lesions on the roots of teeth.


[Editorial: A change of climate].

[Editorial: A change of climate].


Effects of cement bases on the stresses in amalgam restorations. A computerized dental model was used to study the stress induced in a Class 1 amalgam restoration when supported by bases of varying materials and thickness. Under the same load, the maximum tensile stresses and deflections in the amalgam restoration increased at least threefold with a zinc oxide-eugenol base as compared with a ZnPO4 cement base.


Hypodontia: a polygenic trait--a family study among Israeli Jews. A high prevalence of hypodontia was detected among 820 first degree relatives of 305 probands and there was an increased risk if a second family member was affected. Hypodontia is a common trait in the population, and a deviation from normal sex ratio was observed in those affected. These results suggest a polygenic mode of inheritance.


In vivo occlusal forces and moments: I. Forces measured in terminal hinge position and associated moments. Microducers and modified cephalometric roentgenogram techniques were used to study maximum biting forces and moments in an adult male. The force at the second molar was approximately 10% greater than that at the first molar. At the second molar, the moment of force was approximately 15% less than its value at the first molar.


Inhibitory spectrum of a bacteriocinlike substance (mutacin) produced by some strains of Streptococcus mutans. Streptococcus mutans strains were surveyed to determine their lysogenicity. Growth inhibition of the indicator strains around the inoculum of stab culture of some S mutans strains was demonstrated. Many gram-positive bacteria, including mycobacteria and streptomycetes, were sensitive to the antibacterial activity.


Dentinoenamel junction area of a resorbing permanent incisor studied by means of scanning electron microscopy. The surfaces of enamel and dentin that had become separated from each other presumably in the region of the dentinoenamel junction were examined. The enamel surface at the junction was scalloped; the scallops were made of enamel rods. The dentinal surface showed a mirror image picture, tubular in nature. Both surfaces were granulated, which may indicate that apatite crystals from the two tissues intermingle there.


Effect of magnesium on Bacterionema matruchotti calcification.


In vivo occlusal forces and moments: II. Mathematical analysis and recommendations for instrumentation specifications. Mathematical models are derived to describe in vivo maximum occlusal force and moment data generated during mandibular terminal hinge closure for the molars and premolars and for the mandibular central incisors in the straight protrusive position. Recommendations for biting force instrumentation specifications are presented.


Effect of topical applications of neutral sodium fluoride on dental careis in the rat. A study on various regimens by which the same total amount of neutral sodium fluoride is applied to the teeth of rats showed that greater effects were observed after frequent application of 0.2% solutions than after less frequent application of more concentrated solutions.


Editorials: A retirement community: a direct benefit.


Free amino acid pools of cariogenic streptococci.


Electron microscopic study of the cytotoxicity of cadmium and mercury in vitro. The cells treated with cadmium chloride showed severe changes: ribosomes disappeared, mitochondria showed various degrees of destruction, and the endoplasmic reticulum had a swollen and beadlike appearance. In cells treated with mercuric chloride, ribosomes increased in their density and rosette-like polysomes were predominantly observed. The effects of these two metallic ions were discussed.


Effect of exogenous lipid on lipid synthesis by bone and bone cell cultures. Newborn rat calvaria and isolated calvaria cells are capable of de novo lipid synthesis when grown in the presence or absence of exogenous lipid sources. Synthesis decreases when exogenous lipids are supplied. Several cholesterol precursors were found in these tissues and the presence of dihydrocholesterol was established for the first time.


Is dentistry in peril? Our educational institutions and their influence on dental practice.


Extracellular invertase activity from Actinomyces viscosus.


Effect of cooking vessel composition on fluoride.